Use of Mobile Technologies to Improve Healthcare in Mozambique: Key Failure/Success Factors, Challenges, and Policy Implications (Preprint)

BACKGROUND Developing countries are experiencing steady growth in the use of mobile technologies. Globally, the literature on mobile health (or mHealth) interventions, ranging from design and implementation to evaluation, is becoming abundant. But despite this plentiful literature, surprisingly little has been published on the factors and challenges that influence the failure/success of mHealth interventions. In addition, studies that scan in-country mHealth interventions are scarce. OBJECTIVE This study aims to (a) identify and examine various mHealth projects, (b) identify the success/failure factors and challenges relating to mHealth implementation in Mozambique, and (c) present and discuss some mHealth policy implications in Mozambique. METHODS A qualitative, exploratory, descriptive and contextual case study design was used to conduct the study. Semi-structured interviews were conducted with key informants who have been involved with mHealth deployment in Mozambique. The data collected was analysed and then synthesised. The categories and themes that emerged from the data were discussed. RESULTS We found 39 mHealth projects in Mozambique classified as (1) data collection and reporting (n=16), (2) client education and behaviour change communication (n=14), (3) supply chain management (n=6), (4) provider-to-provider communication (n=2), (5) electronic decision support (n=2), and (6) financial transactions and incentives (n=1). Evidence is weak on mHealth implementations and most projects are run by external donors, and hence, the lessons are learned by them individually. In general, mHealth interventions use short message service and/or data features on basic phones, feature phones, smartphones and tablets. Failure factors include insufficient funding, a lack of technical expertise, and regulatory issues. The success factors for implementations that were scaled-up include having multi-sectorial partnerships; training and supervision; quality control measures throughout the service design and delivery; project organisation, management, coordination, and communication; funding; awareness and involvement, and a strong methodology. The challenges include the workloads of healthcare workers, mobile device screen sizes, unreliable internet connections and poor reception, mobile airtime, data accuracy, loss of mobile devices, privacy and safety concerns, the lack of ICT skills, the lack of a proper legal framework and poor regulation, and the lack of coordination and communication among the different project implementers and the government. CONCLUSIONS There is little scientific evidence on mHealth in Mozambique and few advances have been made in order to put in place an mHealth policy and regulatory framework at the national level. We indicate some potential paths for an mHealth policy and regulatory framework as an extension of the eHealth policy, including an organizational structure to support collaboration, plus technical standards and training policies for healthcare professionals.